| NPI | 1407807266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11414) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 5480) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60222657) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2011-10-12 |